Geriatric mental health at CAMH: Delivering care and compassion to a complex patient population

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​CAMH’s Geriatric Mental Health Services treats a medically
complex patient population with a mix of skill, caring and compassion. It
consists of two inpatient Geriatric Assessment Units with a total of 48 beds,
as well as outpatient services.

“I currently have patients on the unit ranging from those
with schizophrenia to depression, bipolar disorder to dementia, substance use
and alcohol use,” explains psychiatrist Dr. Sanjeev Kumar, Head, Geriatric Inpatient
Services. “Because we treat geriatric patients, we are also accustomed to
seeing additional medical issues such as heart disease, diabetes or general
frailty with risk of fractures.”

Despite the medical complexity of the clients, Dr. Kumar
remembers many patient success stories. “We had a patient who was catatonic and
suffering for months with depression and Parkinson’s disease. She was barely
eating and not speaking and would sit still as a stone,” he explains. “She had
been in a mute state for four months. After treatment, she recovered enough to
be discharged to live back with her husband.”

Making a difference

Rong Ting, Manager of Geriatric Inpatient Services and Intake, knows her
team of over 70 staff members makes a difference in the lives of patients with
a complex range of needs.

“We focus on recovery-based treatment so patients can function at their optimal
level,” says Ting.

“There are three pillars to success in our complex care
environment: medical knowledge, communication and compassion,” says Dr. Kumar.
“We are fortunate that all of our team members are inherently compassionate and
empathetic. We bring the human aspect to care, which is the most critical
part.”

Team approach to care

“For each patient, we do a risk assessment to understand what they are
dealing with. We share information with the rest of the team about the
patient’s risks,” says Liza Augustine,
RN. “We discuss goals and interventions to help the patient.”

“We recently attended a dementia symposium education
session. This training helps us learn to get more information about the
patient. Rather than just focusing on the patient’s behaviour, you focus on
intellectual, physical, social and mental issues and address the causes of the
behaviour,” adds Augustine.

Liza’s colleague RN, Sandria
Allen, agrees it is important to look at the causes behind behaviour.
“Sometimes patients come in with aggression, but we may find out physical
symptoms are the cause or contributing to aggression,” explains Allen. “We
focus on holistic care as a team approach to caring for a patient.”

There are dozens of ways the interprofessional team cares
for patients, ranging from 60 to 90 years old, to help them recover and reach
their goals. The approach to care is multifaceted and personalized based on
patient needs.

“I check-in with patients daily on what activities are
available, what they have energy for that day,” says Man-Man Choi, a Recreational Therapist with the Geriatric Assessment Unit. “I
facilitate activities for patients focusing on their physical, cognitive,
emotional and social wellbeing and health.”

Man-Man Choi, Recreational Therapist, and
Efrem Rone, Social Worker on the GAU.

Activities for inpatients range from art, music and dancing to pet therapy and
mindful breathing.

“Sometimes our patients’ abilities and strengths may be
masked by their illness,” explains Choi. “I feel motivated and energetic when I
see patients doing more than I thought they could. For example, we do a music
circle and we have each person shake an instrument when it is their turn. One
patient had trouble knowing when it was her turn in the circle, but then there
was a time when—unprompted—she knew it was her turn. That was my reward.”

Connecting and communicating

“When I say good morning to a patient, right off the bat I can tell how
they are doing at that time,” says Brittany
Mills, Personal Support Worker with GAU. “We do rounds every hour to check
on all patients. Some patients we check on every 15 minutes for their safety.”

Mills often communicates and coordinates with colleagues
including occupational and recreational therapists, physicians, psychiatrists,
housekeeping, environmental services, nurses, social workers, and medical lab
personnel to help support patients’ needs, she explains.

Brittany Mills, Personal Support Worker,
GAU.

Supporting patients

“We ask patients what strength-based interventions have worked for them in
the past to see if we can get them to continue those interventions, such as
book club or swimming, while they are an inpatient,” Efrem Rone, a Social Worker with GAU. “A lot of my work is individual talk therapy or counselling with
patients.”

“I volunteer for monthly group outings with the patients to places like Dufferin
Mall and St. Lawrence Market,” says Rone.

“Our interprofessional team works closely with patients and their families to
find a range of resources and solutions to address their multiple, complex
needs,” says Ting. “It is through
this commitment, compassion and caring that our team helps to advocate for and
support our patients through their recovery.”